Biology Reference
In-Depth Information
3. DRUGS FOR CONTROL OF RELAPSING MALARIA
Elimination of malaria through the administration of medication to an
entire population has the dual attractions of being conceptually simple and
time-limited. Unfortunately, for practical reasons such as the inability to achieve
complete compliance and inherent limitations of the drugs currently available,
examples of vivax malaria elimination using drugs as a primary intervention are
extremely rare. Given the renewed interest and resources committed to malaria
elimination through the GFATM and others recently, mass drug administra-
tion (MDA) is being reconsidered as a potential means to achieve elimination
in some areas with particularly favourable epidemiology (
A research agenda for
malaria eradication: drugs, 2011
). Which drugs to use and under what circum-
stances they should be employed is, however, very uncertain.
3.1. Mass Drug Administration as Public Health Tool
Malaria elimination cannot occur in a vacuum. Unless and until the malaria
burden is decreased to a very small percentage of the population, discussion
of malaria elimination is futile especially in areas which currently experi-
ence year-round transmission (
Hay et al., 2008
). The basic components of
Roll Back Malaria (RBM) are rapid treatment of malaria cases with effective
drugs and distribution of ITN to lower both malaria mortality and morbidity.
Adequate treatment in this context means not just decreasing the parasitaemia
in order to abate symptoms but actual cure meaning killing the last parasite.
All antimalarial programs have to include the task of locating and adequately
treating those persons infected with malaria. Elimination of malaria is a fur-
ther development of this concept when areas under extremely good malaria
control are advanced into an elimination phase with the goal of killing the
last parasite not in the individual, but in the entire population. A large pulse
of antimalarial medication through an entire area's population in order to
eliminate residual parasites and block transmission until all infective mosqui-
toes have died could be the final phase in a long campaign prior to long-term
surveillance primarily aimed at excluding new imported infections.
Other quite justified uses of antimalarial drugs must be differentiated
from medication used to treat clinical cases during malaria control or elimi-
nation activities. Full treatment regimens of antimalarial medication have
been successfully used to decrease malaria episodes when given to children
with their standard immunizations during the first year of life (intermittent
preventive treatment of infants or IPTi) (
Greenwood, 2007
) or to protect
